Organization
GRANT MEMORIAL HOSPITAL
Active
Other names
Potomac Valley Family Medicine-Petersburg
Organization subpart
No
Provider details
NPI number
Authorized official
SANDY M MICHAELS (CHIEF FINANCIAL OFFICER)
(305) 257-1026
Entity
Organization
Contact information
Practice address
8 LEE ST, SUITE 3, MOOREFIELD, WV 26836-1091
(304) 538-7707
(304) 538-7706
Mailing address
PO BOX 1019, PETERSBURG, WV 26847-1019
(304) 257-1026
(304) 257-1932
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0001375015
—
WV
Enumeration date
07/13/2005
Last updated
08/22/2020
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